The keynote address at last week’s 2013 Public Health Law Research (PHLR) annual meeting was from Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.
“People are just beginning to wake up to the knowledge that behavioral health [issues are] so common and that half of all Americans have a mental health issue at sometime in their lives,” Hyde told meeting attendees. Depression, according to the World Health Organization, is the most common medical disorder worldwide. And among the eight million people in the past year who had a mental illness or a substance abuse disorder, only 6.9 percent received treatment.
“The country has to spend as much time helping children develop their emotional skills as they do their soccer skills,” said Hyde.
Just prior to the PHLR meeting, NewPublicHealth spoke with Administrator Hyde about public health law research and some new initiatives aimed at helping address behavioral health in the United States.
NewPublicHealth: What research is critically needed on mental health issues to help improve awareness and treatment?
Pamela Hyde: Often people don’t think of behavioral health as part of the larger public health message or initiatives or infrastructure in the country and so they don’t think about mental health research when they think about other kinds of public health research. But you can think about behavioral health needs in the same way. It is just important to protect people from lost hope as it is to protect them from bacteria in the water.
The types of research I think we need are continuing efforts about how to engage people in behavioral health treatment, what prevents that from happening, what causes public health emergencies or harm either to people with behavioral health needs or to the population as a whole.
We need to talk about laws that treat people with mental health issues based on their diagnosis and their illness rather than based on any kind of criteria for a danger they may pose or their ability to handle weapons.
Co-morbidities such as diabetes and alcohol or depression, for example, can push the diabetes care cost somewhere between four and five times more especially when the co-morbidities have been untreated. Physicians are looking at that now, and hospitals that are trying to reduce readmissions are looking at their data and realizing how much of the readmissions are based on substance abuse or mental health issues.
You can’t have good health without good behavioral health.
NPH: How do we educate the public, including policymakers, that mental health is more common than they think, but also treatable?
Pamela Hyde: The President has said we’ve got to bring mental health out of the shadows, and I think that’s exactly it. If we continue to have misunderstanding and misinformation about mental health and substance abuse, then people are going to be unwilling to say they have a problem, unwilling to say, gosh I think my kid has a problem. We’ve got to have that conversation.
We’ve also got to disconnect the discussion about mental health from the discussion about violence. While there is no question that some people with mental health problems perpetrate violent acts, so do lots and lots and lots of people who don’t have mental health problems. We’ve got to make sure that people understand that people with mental health problems can and do recover — it’s not a sentence for a chronic illness from which one can never emerge. There’s a lot of negative attitudes that arise out of that misinformation.
One new initiative is on something called mental health first aid, especially in schools, to help young people, their teachers and parents, learn about these issues: how to recognize the signs and how to seek help and get help for others.
NPH: What more do we need to put into place so that we’re better able to help people with mental health problems or people who might develop mental health crises as a result of a disaster?
Pamela Hyde: This is also an area where I think states and communities and public officials are really starting to see that in addition to physical impact, there are also trauma issues going on. And, often, people in these situations bring their histories of trauma to the event occurring as well. We’re trying to think about how to build resilient communities and how to build resilient people because probably everybody in this country is going to face some trauma at some point in their lives. The question is do you have the resources and the resilience to bounce back from it? The behavioral health community, especially state mental health commissioners across the country, has always been involved in disaster planning, but I think increasingly they are working with their public health officials. And leaders in and states and counties are realizing that they need behavioral health people at the table from the day the disaster happens, and now behavioral health people are included in the planning efforts and the practice exercises. The federal government has some capacity to send teams into a disaster area; there was a mental health team that was sent into Newtown for a while to help that community address some of the immediate issues.
We work with state and local officials and providers on preparedness. And we’ve also created a disaster distress help line that’s available 365 days a year, 24/7; it doesn’t have to be brought online when a disaster happens. It’s always going because frankly, there’s a disaster going on around the country almost every day. It is connected to a whole nationwide group of crisis centers, so if something happens in New York and a resident of that area calls the number, the local New York crisis centers will respond. If they get overwhelmed by the number of calls, the system will automatically send those calls to the next closest crisis center.
NPH: We asked Scott Burris, head of the Public Health Law Research Program to pose some questions for you. The first is: what would SAMHSA say are the most important questions you need answered by the legal research community?
Pamela Hyde: There are some key laws that are on the books or are interpreted in ways that have new implications in the new world. For example, we have different laws for consent for substance abuse than we do for other areas. So, that’s a legal issue we need some guidance on. And we have a new mental health parity law that has only been around since 2008. Obviously, there were predecessors to that law, but the final regulations will be completed in 2013. Part of what we’re struggling with in that law is learning what the implications are.
There are also issues with mental health related to guns, which states interpret differently and that is a space for interface between the mental health community and the legal community and needs additional research.
NPH: Scott Burris’ second question is: what will it take going forward for SAMHSA to be most effective in the years ahead?
Pamela Hyde: Well, I think I’d boil that down to two things. One is an understanding of behavioral health’s unique history, unique laws, unique funding streams, and unique structure in the U.S. We’re an operating division of the Department of Health and Human Services so we are equivalent to FDA and CDC for example, but we’re unique in that we’re the only operating division that focuses on a set of conditions. We have a great need, in order to have a greater impact, to be seen as a public health agency, not just as a grant-making agency. We do make grants. That’s a terrific role. We like that role. We do it well. But we also do the major surveillance work in the country around behavior health. We also do major practice improvement work for the workforce. We do lots of public education the same way CDC does. We also provide leadership and voice for the issue. So, a critical thing is to have the country understand behavioral health and understand SAMHSA as a unique agency that’s really there for them on these issues.
The second thing is probably obvious, we don’t have enough money. Nobody does in this environment, and that is one of the things that we struggle with. We are trying to be as effective as we can be within the limited resources that we have, and as a consequence, one of the things that we really see ourselves doing these days is focusing less on just the money that we are responsible for and taking seriously our role at influencing other funding streams — Medicaid and Medicare, private insurance, and other grant-making organizations.
NPH: What is SAMHSA’s particular role is in helping to prevent gun violence and what specific efforts are underway?
Pamela Hyde: People with mental health issues are much more likely to be victims than they are to be perpetrators. The data that we have suggests that people with mental health issues who do commit acts don’t do it with guns any more or any less than anybody else. The issues about how people conduct themselves around violence and how people use guns appropriately or inappropriately, really has to do more with things such as age, gender, impoverished conditions, availability of guns and knowledge about gun safety.
So, our role in this is really to be clear about that message, and to support CDC. We’ve been working closely with them because their job really is to explore this issue of violence as a public health issue, and you have to look at what the precursor of a violent act is. Is it mental health and alcohol issues and drug issues? Or is it divorce? Is it a trauma of some sort? Is it domestic violence? Is it some criminal behavior? What happened before the violent act that led to it and was there a prevention opportunity that was lost?
We also have a significant role in a number of mental health initiatives announced this week. Healthy Transitions is a focus on the 16 to 25 year old age group, and it goes back to the issue of young people and their families not always feeling comfortable seeking help and getting help.
We’re also doing some work on workforce, with the Health Resources and Services Administration (HRSA). There’s a new initiative being proposed for SAMHSA and HRSA to train about 5,000 more mental health professionals, trying to focus on students and young adults. And, Secretary Sebelius called on the nation this week to spend the year having a national dialogue about mental health in a different way. Really trying to underscore this issue of needing people to understand it, be able to recognize it, see the signs and symptoms, stop having misunderstandings that lead too many people to be shameful about it so they won’t seek help. We want to have people feel comfortable seeking help, and frankly, we want to have people supportive of prevention efforts. We don’t want to wait until people need help, we want to really work with our young people and our schools and communities to try to help young people have the kind of development and resilience they need to grow up healthy behaviorally as well as physically.
Updated: January 30 2013